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Aspirin

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Aspirin

NIH - Aspirin “Prescription aspirin is used to relieve the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), osteoarthritis (arthritis caused by breakdown of the lining of the joints), systemic lupus erythematosus (condition in which the immune system attacks the joints and organs and causes pain and swelling) and certain other rheumatologic conditions (conditions in which the immune system attacks parts of the body). Nonprescription aspirin is used to reduce fever and to relieve mild to moderate pain from headaches, menstrual periods, arthritis, colds, toothaches, and muscle aches. Nonprescription aspirin is also used to prevent heart attacks in people who have had a heart attack in the past or who have angina (chest pain that occurs when the heart does not get enough oxygen). Nonprescription aspirin is also used to reduce the risk of death in people who are experiencing or who have recently experienced a heart attack. Nonprescription aspirin is also used to prevent ischemic strokes (strokes that occur when a blood clot blocks the flow of blood to the brain) or mini-strokes (strokes that occur when the flow of blood to the brain is blocked for a short time) in people who have had this type of stroke or mini-stroke in the past. Aspirin will not prevent hemorrhagic strokes (strokes caused by bleeding in the brain). Aspirin is in a group of medications called salicylates. It works by stopping the production of certain natural substances that cause fever, pain, swelling, and blood clots.”

NHS - Anti-platelets, aspirin, low dose “Antiplatelet medicines reduce the risk of clots forming in the blood. Normally, when there is a cut or break in a small blood vessel, a blood clot forms to plug the hole until the blood vessel heals. Small cells in the blood called platelets make the blood clot. When a platelet detects a damaged area of a blood vessel, it produces a chemical that attracts other platelets and makes them stick together to form a blood clot. Aspirin reduces the ability of the platelets to stick together and reduces the risk of clots forming. … Low dose aspirin should not be taken if you have: • an active peptic ulcer, • haemophilia or other bleeding disorder, or • an allergy to aspirin or to NSAIDs (for example, ibuprofen or diclofenac). Aspirin must not be given to anyone under 16 years old, unless under specialist advice. Low dose aspirin should be taken with caution if you have: • asthma, • uncontrolled high blood pressure, • had a previous peptic ulcer, • liver problems, or • kidney problems. Occasionally some people are advised to stop taking aspirin seven days before a planned operation. This should always be on the advice of your doctor or surgeon.”

NHS - Reye's syndrome “You should not give children under the age of 16 aspirin, or medicines that contain aspirin, unless your doctor specifically advises you to do so. Other names for aspirin include: • acetylsalicylic acid, • acetylsalicylate, • salicylic acid, and • salicylate. If your child or teenager has flu (influenza) or another viral infection, you should use ibuprofen or paracetamol to reduce their fever or relieve pain. Ibuprofen is not recommended if you have a history of asthma, kidney or liver disease. Some under-16s have specific conditions that need treatment with drugs that contain aspirin. If your child has one of these conditions, your doctor may decide that the benefit to their condition outweighs the risk of taking the aspirin-containing medicine. If your doctor advises your child to take aspirin, they will usually also advise your child to have the chickenpox and flu (influenza) vaccine, to reduce the risk of them developing Reye's syndrome. “

Daily aspirin therapy: Understand the benefits and risks - Is an aspirin a day the right thing for you? It's not as easy a decision as it sounds. Know the benefits and risks before considering daily aspirin therapy.

Should I take daily aspirin to prevent a heart attack or a stroke?

Highlighted Articles

Aspirin resistance: disparities and clinical implications. (Pharmacotherapy. 2008) “Aspirin is one of the most widely prescribed drugs for the prevention of thrombosis in patients with vascular disease. Yet, aspirin is unable to prevent thrombosis in all patients. The term "aspirin resistance" has been used to broadly define the failure of aspirin to prevent a thrombotic event. Whether this is directly related to aspirin itself through biochemical aspirin resistance or treatment failure, or if it is because of aspirin's inability to overcome the thrombogenic aspects of the disease process itself, has not been elucidated. This can have dramatic clinical implications for a variety of vascular disease subsets and is cause for concern, considering the high prevalence of aspirin use for both primary and secondary prevention. Disparities exist in the rates of aspirin resistance among certain patient populations, such as women, patients with diabetes mellitus, and those with heart failure, and across clinical conditions, such as cardiovascular and cerebrovascular disease.”

Aspirin for Women: Yes or No? (2007) "Women who regularly took high-dose aspirin … more than 14 adult-strength tablets a week -- did not get a health benefit. Instead, they were 43% more likely to die from hemorrhagic stroke compared with those who never took aspirin. Hemorrhagic stroke is stroke due to bleeding in the brain … Older women and women with pre-existing risk factors for heart disease got the largest benefit from regular low- or moderate-dose aspirin. … "There are suggestions here that there is a subgroup of women for whom regular aspirin makes sense," Chan tells WebMD. "But no one should take aspirin therapy on her own. This still requires a thorough discussion of individual risks and benefits with a doctor." … "These new findings by Chan et al. cannot overcome the accumulated evidence that aspirin is not particularly effective for the primary prevention of death from cardiovascular disease in women," Baron and colleagues note."

Aspirin may lower death risk in women (2007) "Aspirin in low to moderate doses may lower the risk of death in women, particularly those who are older and prone to heart disease, a 24-year study of nearly 80,000 women suggests. However, experts cautioned that the results are not definitive and that women should not take aspirin as a health preventive without talking to their doctor. In this long-running study of nurses who were middle-aged and older, women who took aspirin had a 25 percent lower risk of death compared with those who never took it. Aspirin-takers had a 38 percent lower risk of death from cardiovascular disease and a 12 percent lower risk of death from cancer. "

Aspirin Dose for the Prevention of Cardiovascular Disease (JAMA. 2007) "Conclusions Currently available clinical data do not support the routine, long-term use of aspirin dosages greater than 75 to 81 mg/d in the setting of cardiovascular disease prevention. Higher dosages, which may be commonly prescribed, do not better prevent events but are associated with increased risks of gastrointestinal bleeding."

Highlighted Internet Site

NIH NTP-CERHR: Common Concerns - Aspirin (Center for the Evaluation of Risks to Human Reproduction)

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Aspirin

General Information

NEWS:

Aspirin Associated With Reduced Colorectal Cancer Risk in Men

Aspirin Could Reduce Breast Cancer And Help Existing Sufferers, Review of Studies Suggests “Anti-inflammatory drugs like aspirin may reduce breast cancer by up to 20 per cent, according to an extensive review carried out by experts at London's Guy's Hospital. But they stress that further research is needed to determine the best type, dose and duration and whether the benefits of regularly using non-steroidal anti-inflammatory drugs (NSAIDs) outweigh the side effects, especially for high-risk groups.”

Aspirin may help prevent asthma in women “In an editorial published with the study, Dr. Andrew A. Clayton and colleagues at the Centre for Respiratory Research in Nottingham, UK, point out that women in the aspirin group had a significantly increased risk of gastrointestinal bleeding requiring blood transfusion. "It is debatable," they say, "whether such a risk is acceptable in order to achieve the reduction in asthma risk." They agree with the Harvard team's conclusion that "before public recommendations are provided, results from randomized trials are needed that are specifically designed to test whether low-dose aspirin reduces the risk of asthma." “

Aspirin may mask prostate cancer, study hints “They found that the use of aspirin was significantly associated with lower PSA levels. After accounting for other factors that might influence the results, PSA levels were 9 percent lower in men taking aspirin relative to those who were not.”

Benefits Of Aspirin For Treating Osteoporosis Uncovered

Diabetes aspirin use questioned

Many Stroke, Heart Attack Patients May Not Benefit From Aspirin, Study Suggests “Up to 20 percent of patients taking aspirin to lower the risk of suffering a second cerebrovascular event do not have an antiplatelet response from aspirin, the effect thought to produce the protective effect, researchers at the University at Buffalo have shown.”

What initial dose of aspirin is right for STEMI patients? “An initial dose of 162-mg aspirin may be as effective as and perhaps safer than 325 mg for the acute treatment of ST-elevation MI (STEMI), a new study suggests [1].”

ARTICLES:

Daily aspirin therapy: Understand the benefits and risks

JOURNAL ARTICLES:

Aspirin administered to women at 100 mg every other day produces less platelet inhibition than aspirin administered at 81 mg per day: implications for interpreting the women's health study. (J Thromb Thrombolysis. 2008) “We observed that the degree of platelet inhibition was significantly less with aspirin 100 mg every other day compared with aspirin 81 mg daily, suggesting that results of the Women's Health Study may have underestimated both the efficacy and toxicity of aspirin as it is commonly administered. These data need to be considered when developing recommendations about the use of aspirin in the primary prevention of cardiovascular disease in women.”

Aspirin in Alzheimer's disease (AD2000): a randomised open-label trial. (Lancet Neurol. 2008) “INTERPRETATION: Although aspirin is commonly used in dementia, in patients with typical AD 2 years of treatment with low-dose aspirin has no worthwhile benefit and increases the risk of serious bleeds.”

Aspirin resistance: disparities and clinical implications. (Pharmacotherapy. 2008) “Aspirin is one of the most widely prescribed drugs for the prevention of thrombosis in patients with vascular disease. Yet, aspirin is unable to prevent thrombosis in all patients. The term "aspirin resistance" has been used to broadly define the failure of aspirin to prevent a thrombotic event. Whether this is directly related to aspirin itself through biochemical aspirin resistance or treatment failure, or if it is because of aspirin's inability to overcome the thrombogenic aspects of the disease process itself, has not been elucidated. This can have dramatic clinical implications for a variety of vascular disease subsets and is cause for concern, considering the high prevalence of aspirin use for both primary and secondary prevention. Disparities exist in the rates of aspirin resistance among certain patient populations, such as women, patients with diabetes mellitus, and those with heart failure, and across clinical conditions, such as cardiovascular and cerebrovascular disease.”

Aspirin "Resistance" (Herz. 2008) “Recent clinical studies have shown that the expected antiplatelet effect of aspirin is not always achieved. From the laboratory point of view, resistance to aspirin is the inability to achieve the expected inhibition of platelet cyclooxygenase-(COX-)1 with prevention of platelet thromboxane (TX) A2 formation. The failure to prevent atherothrombotic events (treatment failure) must be distinguished from aspirin resistance. Nevertheless, different definitions of aspirin resistance complicate the assessment of published data, a problem aggravated by discordant results of the available diagnostic laboratory techniques.The pharmacological mechanisms of aspirin resistance are not completely understood. Potential causes include pharmacokinetic and pharmacodynamic issues, such as reduced bioavailability, increased platelet turnover, interactions with nonsteroidal anti-inflammatory drugs, comorbidities (hypercholesterolemia or diabetes mellitus), alternative pathways of platelet activation, and genetic polymorphisms. Clinical trials demonstrated a negative impact of aspirin resistance on the clinical outcome: an about fourfold increased risk of major atherothrombotic events has been found in aspirin nonresponders suffering from vascular disease.”

Aspirin, clopidogrel, and warfarin: is the combination appropriate and effective or inappropriate and too dangerous? (Ann Pharmacother. 2008)

Failure of aspirin to prevent myocardial infarction and adverse outcome during follow-up - a large series of all-comers. (Ann Med. 2008)

Low dose aspirin and cognitive function in middle aged to elderly adults: randomised controlled trial. (BMJ. 2008)

NSAID use and dementia risk in the Cardiovascular Health Study (NEUROLOGY 2008) “Conclusions: Results were consistent with previous cohort studies showing reduced risk of AD in NSAID users, but this association was found only in those with an APOE 4 allele, and there was no advantage for Aß42-lowering NSAIDs.”

Regular Adult Aspirin Use Decreases the Risk of Non-Small Cell Lung Cancer among Women (Cancer Epidemiol Biomarkers Prev 2008) “Conclusion: Our results suggest that long-term use of adult-strength aspirin may reduce the risk of NSCLC in women.”

The benefit of aspirin therapy in type 2 diabetes: What is the evidence? (Int J Cardiol. 2008)

The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease (BMJ 2008) “Conclusion This trial does not provide evidence to support the use of aspirin or antioxidants in primary prevention of cardiovascular events and mortality in the population with diabetes studied.”





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